3 - PSY - Anxiety Disorders

Question 1

Which four features distinguish pathological anxiety from normal anxiety

Answer 1

autonomy - no/min env trigger
intensity - exceeds pt capacity to deal with discomfort
Duration = Sx are persistent
Behaviour - impairs function +/or results in disabling behaviours

Question 2

2 classifications of anxiety disorders?

Answer 2

constant - GAD

episodic - Phobias, panic, PTSD, OCD

Question 3

Psych arousal Sx

Answer 3

worrying thoughts
irritable
noise sensitive
restless
fearful anticipation
poor concentration

Question 4

Sleep disturbance Sx

Answer 4

insomnia

night terrors

Question 5

Muscle tension Sx

Answer 5

tremors

aches

Question 6

Autonomic arousal Sx

Answer 6

dry mouth
diarrhoea
difficulty breathing
palpitations
chest discomfort
frequent and urgent urination

Question 7

4 components of the cycle of anxiety?

Answer 7

thoughts
behaviour
emotions
bodily responses

Question 8

Generalised Anxiety Disorder - criteria

Answer 8

neither situational or episodic
Sx involve elements of - Apprehension, Motor tension, Autonomic over activity
general and persistent psych and somatic anxiety Sx on most days for at least several weeks

Question 9

Panic disorder - ICD 10 criteria

Answer 9

• several attacks within one month
• circumstances with no objective danger
• not confined to known or predictable situations
• relatively free from anxiety Sx between attacks

Question 10

Panic disorder - Sx

Answer 10

unpredictable panic attacks
sudden crescendo of severe anxiety
catastrophic cognition (im dying)
Short lived (<10 mins normally)

Question 11

Agoraphobia - icd criteria

Answer 11

psych and auto Sx primarily from anxiety and not secondary to other Sx
Anxiety restricted to at least two of following - crowds, public places, travelling alone, travelling away from home
avoidance of phobic situation = prominent feature

Question 12

Social phobia - Sx

Answer 12

fear of being focus of attention
Sx restricted to situation/thinking about situation
Common Sx - blushing, shaking, fear of vomiting, urgency/frequency
Avoidance

Question 13

Characteristics of OCD

Answer 13

obsessive Sx (thoughts, impulses, images) +/or compulsive acts or rituals - causing distress + interferes with activities

Question 14

What do OCD Sx frequently co exist with

Answer 14

schizophrenia
tourette’s
depression

Question 15

Obsessions - describe

Answer 15

• thoughts ideas images
• repetitive
• excessive/unreasonable
• unpleasant (no pleasure)
• originate in mind of patient

Question 16

Compulsions - describe

Answer 16

• physical act
• excessive/unreasonable
• repetitive
• resisted by patient
• unpleasant (may relieve tension/anxiety)
• originates in mind of pt

Question 17

rule these out as causes of anxiety before reaching a psych diagnosis

Answer 17

drugs 
drug withdrawal
cardiac arrhythmias
neuro (seizures)
hypoxia (CHF, COPD, angina, anaemia)
Metabolic (acidosis, hyper/hypo thermia)
endocrine (thyroid)

Question 18

How do patients manage their own anxiety?

Answer 18

Avoidance and Safety behaviours

Question 19

NICE step care approach - 4 steps

Answer 19

1 - psychoeducation and active monitoring
2 - guided self help and low intensity psych interventions
3 - high intensity psych Tx (CBT) or drug Tx
4 - referral to secondary care - MDT approach

Question 20

CBT methods for phobias and OCD

Answer 20

OCD - exposure and response prevention

Phobias - systematic desensitisation or graded exposure

Question 21

4 types of meds used to Tx anxiety

Answer 21

Antidepressants
Beta Blockers
Benzos
Antipsychotics (beneficial in severe cases)

Question 22

Antidepressants use in anxiety + counselling

Answer 22

all are anxiolytic

warn pt of possible increase in anxiety in initial period

Question 23

Benzos - short and long half life examples - use - beware of…?

Answer 23

short half life - lorazepam
long half life - diazepam

use in short term acute management (<4 weeks) as can be addictive

can reduce psych Tx efficacy

Question 24

Acute stress reaction - describe briefly

Answer 24

brief response to severely stressful events

Question 25

acute stress reaction Sx

Answer 25

anxiety/depression
pts may already use coping strategies (denial, avoidance)
alcohol excess common
(numbness, detachment, derealisation, insomnia, restless, nger etc)

Question 26

Management of Acute stress reaction

Answer 26

reduce emotional response by talking about it
encouraging but not forcing recall
learn coping skills
anxiolytic if severe anxiety
hypnotics if severe sleep disturbance

Question 27

Adjustment disorder - describe briefly

Answer 27

psych reaction to new circumstance
related to and in proportion to stressful event
most lasts a few months

Question 28

Adjustment disorder - Sx

Answer 28

anxiety/depression/irritable
autonomic arousal Sx
occasional outbursts
Alcohol/drug abuse common
impaired social Fx
more gradual onset than acute stress reaction

Question 29

Adjustment disorder - mgmt

Answer 29

help resolve change
prevent avoidance and denial
relieve anxiety through talk
consider talking therapy referral

Question 30

Sx indicating abnormal reaction to loss (abnormal grief)

Answer 30

• guilt about things other than actions at time of death
• ‘im better off dead/i shouldve died with them’
• morbid preoccupation with worthlessness
• psychomotor retardation
• prolonged + serious Fx impairment
• hallucinations beyond hearing/seeing deceased person transiently

Question 31

PTSD core triad of Sx

Answer 31

hyperarousal
re-experiencing
avoidance

Question 32

Other Sx of PTSD

Answer 32

depressive + guilt
substance use for coping
Sx may begin quickly after, rarely >6months after

Question 33

PTSD management

Answer 33

Psych Tx - education, CBT, Eye movement desensitisation and reprocessing
bio - antidepressants
social - avoid substances, educate family, reintegration to society